Joint injuries may commonly result in the complete or partial detachment of ligaments, tendons, and soft tissues from bone. Tissue detachment may occur in many ways, e.g., as the result of an accident such as a fall, overexertion during a work related activity, during the course of an athletic event, or in any one of many other situations and/or activities. These types of injuries are generally the result of excess stress or extraordinary forces being placed upon the tissues.
In the case of a partial detachment, commonly referred to under the general term “sprain,” the injury frequently heals without medical intervention, the patient rests, and care is taken not to expose the injury to undue strenuous activities during the healing process. If, however, the ligament or tendon is completely detached from its attachment site on an associated bone or bones, or if it is severed as the result of a traumatic injury, surgical intervention may be necessary to restore full function to the injured joint. A number of conventional surgical procedures exist for re-attaching such tendons and ligaments to bone.
One such procedure involves forming aligned femoral and tibial tunnels in a human knee, such as in repairing a damaged anterior cruciate ligament (“ACL”). A bone block or anchor with a ligament graft attached thereto is passed through the tunnels to a blind end of the femoral tunnel where the block or anchor is fixed in place. The ligament extends out of the tibial tunnel, and the end is attached to the tibia cortex by staples or the like. Alternatively, the end of the ligament may be fixed in the tibial tunnel by an anchor or by an interference screw. Various types of ligament and/or suture anchors for attaching soft tissue to bone are well known in the art.
One method for anchoring bone blocks in bone tunnels is through cross-pinning, in which a cross pin such as a pin, screw, or rod is inserted into the bone, transversely to the bone tunnel, so as to intersect the ligament graft and/or the bone block, to “cross-pin” the graft in the bone tunnel. The cross pin is generally placed in a pre-drilled tunnel in the bone that is prepared using a drill guide.
In addition, considerations for cross-pinning graft ligaments in the tibia differ from considerations for cross-pinning of graft ligaments in the femur. These considerations include differences in anatomical geometry, bone quality, and other considerations. These different requirements generally result in the development and application of different cross-pinning guides for femoral and tibial cross-pinning, adding complexity and expense to the performance of tissue reattachment surgeries such as ACL replacement surgeries.
Accordingly, there is a need for improved methods and devices for repairing ligaments and for positioning and forming bone tunnels.